Endoscopic surgery, such as arthroscopically repairing torn rotator cuffs of the shoulder requires instruments designed to operate at remote operation sites accessible through a narrow cannulae. Usually, arthroscopic suturing of tissue requires manipulation of a needle being held and controlled by a surgeon through an intermediate device, that is, in arthroscopic surgery a doctor's hands are unable to directly grasp the needle, thus a number of suturing devices have been provided to allow manipulation by the surgeon of a needle at a remote operation site.
Arthroscopic surgery, as the term is used herein, is used to describe surgery on various body parts requiring only small incisions or portals for insertion of surgical instruments manipulated externally of the body. Such surgery includes operation on the joints, and is preferable over open surgery to avoid the trauma associated with large incisions as well as the hospitalization and prolonged recovery periods required with open surgery.
Arthroscopic techniques include internal viewing for diagnosis and identification of problems as well as surgical operations such as meniscus removal or repair, shaving of irregular, roughened patella, and other surfaces and articular surface smoothing. Many surgical operations that previously required open surgery can now be performed arthroscopically. However, due to the need for direct suturing, such as a major ligament and/or cartilage repair, many operations that would benefit from arthroscopic surgery still require open surgery.
U.S. Pat. Nos. 4,602,635 and 4,621,640 to Mulhollan et al. are representative of prior art instruments for internal suturing without requiring open surgery. However, such instruments have the disadvantages of being mechanically complex and requiring multiple instrument manipulation for suturing of the tissue. The instrument of Mulhollan et al., U.S. Pat. No. 4,621,640, includes curved needle carried by a pivotal head movable to cause the needle to be set and the tissue to be sutured, the needle then being released and the instrument withdrawn to allow insertion of another instrument to pull the needle through. The Mulhollan et al. U.S. Pat. No. 4,602,635 relates to an instrument for tying knots in sutures in a manipulation area external to the body after sutures are sewn through the tissue and pushing the knots into place adjacent to the tissue.
U.S. Pat. No. 4,923,461 (Caspari et al.) discloses a method and device for suturing tissue arthroscopically including a fixed and movable jaw, the fixed jaw having a curved, hollow needle attached and the movable jaw having a slot which, when flush with the fixed jaw, allows the needle to penetrate therethrough. However, the Caspari et al. device is needlessly complex, requiring a fixed needle and limiting the ability of the surgeon to push the needle completely through a ligament.
None of the devices provide for a simple, easy-to-use instrument for grasping and manipulating a curved needle.